Digital support for quality assurance in 24-hour caregiving at home: a randomized controlled trial investigating the effects on quality of life and professional skills of paid 24h-caregivers

Background Regarding the care of older adults, 24-h home-care represents a cornerstone, with > 32,000 service users in Austria. Our research project 24hQuAALity aimed to develop and evaluate a distributed client-server software solution for the support and quality assurance of this home-care service. In this trial, we investigated the effects of this intervention on the quality of life and professional skills of paid 24h-caregivers in Austria. Methods The application used in our study comprises an e-learning platform, an integrated emergency management, networking opportunities, and an electronic care documentation system in the native language of the 24h-caregivers. The trial was conducted using a parallel three-arm study design to evaluate (i) a control group, which performed usual home care, (ii) a partial intervention group, which used the e-learning and networking platforms, and (iii) a full intervention group, which used the entire intervention (e-learning platform, networking platform, and digital care documentation). Primary self-reported outcomes were the standardized ASCOT for Carers score and a score based on responses to project-specific efficacy questions. Results Among the 110 24h-caregivers who were randomly classified into the three groups, ASCOT for Carers score data were available for 57 and 35 24h-caregivers at 5- and 9-month follow-up examinations, respectively. At 9 months, 24h-caregivers receiving any intervention rated the ASCOT for Carers score (not significantly) better than the controls (p = 0.05, ηp2 = 0.15), mainly in the domain “feeling encouraged and supported”. At 9 months, 24h-caregivers receiving any intervention rated the project-specific Efficacy score significantly better than the controls (p = 0.02, ηp2 = 0.20), mainly due to better ratings in the subitems “satisfaction with current docu”, “docu supports doing my job”, “ I’m well prepared for emergencies”, “my professional skills are adequate for doing my job”, and “communication with contacts”. Conclusions Providing e-learning and e-documentation devices to 24h-caregivers improved their care-related quality of life, mainly because they felt more encouraged and supported. Moreover, these interventions improved their self-perceived professional skills. As an extrapolation of findings, we found that these interventions could empower 24h-caregivers and improve the quality of home-care services provided by them. Trial registration Digital Support for Quality Assurance in 24-h Caregiving at Home was registered and posted on the ClinicalTrials.gov public website (ClinicalTrials.gov Identifier: NCT04581538). Supplementary Information The online version contains supplementary material available at 10.1186/s12877-023-04454-4.


Table of supplementary content
: Scoring scheme for professional experience (range: 0-5) Page 7: Table S2.ASCOT score descriptive statistics (numeric details corresponding to figure 2) Page 7: Table S3.Efficacy score descriptive statistics (numeric details corresponding to figure 3) Page 8: Table S4.Follow-up 1 (month 5) ANCOVA ASCOT (baseline value as covariate) comparison control vs. any intervention Page 9: Table S5.Follow-up 1 (month 5) ANCOVA ASCOT (baseline value as covariate) comparison partial vs. full intervention Page 10: Table S6.Follow-up 2 (month 9) ANCOVA ASCOT (baseline value as covariate) comparison control vs. any intervention Page 11: Table S7.Follow-up 2 (month 9) ANCOVA ASCOT (baseline value as covariate) comparison partial vs. full intervention Page 12: Table S8.Follow-up 1 (month 5) ANCOVA efficacy survey (baseline value as covariate) comparison control vs. any intervention Page 14: Table S9.Follow-up 1 (month 5) ANCOVA efficacy survey (baseline value as covariate) comparison partial vs. full intervention Page 16: Table S10.Follow-up 2 (month 9) ANCOVA efficacy survey (baseline value as covariate) comparison control vs. any intervention Page 18: Table S11.Stratified randomization was applied based on the care level of the care receiver and the professional experience level of the 24h-caregivers in order to achieve balanced treatment allocation among these covariates.Cut-offs were set at the median of care levels and professional experience levels from a subsample of households enrolled before study commencement.Consequently, two dichotomous covariates resulted in four combinations of covariate outcome combinations (i) low care level -low professional experience, (ii) low care level -high professional experience, (iii) high care level -low professional experience, and (iv) high care level -high professional experience.Based on screening assessments, each household was classified into one of these four covariate combinations.The professional experience of 24h-caregivers was assessed with a newly developed scheme (supplementary table S1) that incorporates the duration of professional experience as well as the specific and general level of education.Two hundred (200) sets of three unique integer numbers per set (1, 2, 3) were generated by an online sequence generator tool.The numbers 1, 2, and 3 were replaced by the allocations (i) control, (ii) partial intervention, and (iii) full intervention, and consecutively listed under the four aforementioned covariate outcome combinations.Stratification criteria were assessed within the baseline survey.Households were then assigned in blocks of three.Group allocation was thus concealed at the time of the baseline assessment and revealed at the time of tablet dispensing preparation.

ASCOT score calculation details
The ASCOT score was calculated as 1-(x-1)*⅓, where "1-" turned the more positive outcome to a higher value, "x" represents the mean of seven items included in the index, "1" represents the smallest valid item value, and "⅓" represents the chosen maximum of the transformed index metric divided by the range of item values.

Efficacy score calculation details
The Efficacy score was calculated as (x-1)*¼, where the range of item values was 4, and cases were included if at least 10 out of 14 items were validly completed.

Follow-up 2
(month 9) ANCOVA efficacy survey (baseline value as covariate) comparison partial vs. full intervention Page 20: Table S12.Pearson's correlations of baseline data with follow-ups for variance inspection for ASCOT score and Efficacy score Page 21: Figure S1: Beeswarm plot and corresponding boxplots for the ASCOT score at baseline Page 22: Figure S2: Beeswarm plot and corresponding boxplots for the ASCOT score at the 5-month follow-up Page 23: Figure S3: Beeswarm plot and corresponding boxplots for the ASCOT score at the 9-month follow-up Page 24: Figure S4: Beeswarm plot and corresponding boxplots for the Efficacy score at baseline Page 25: Figure S5: Beeswarm plot and corresponding boxplots for the Efficacy score at the 5-month follow-up Page 26: Figure S6: Beeswarm plot and corresponding boxplots for the Efficacy score at the 9-month follow-up Stratified randomization -detailed description

Figure S1 :
Figure S1: Beeswarm plot and corresponding boxplots for the ASCOT score at baseline

Table S2 .
ASCOT score descriptive statistics (numeric details corresponding to figure2)

Table S3 .
Efficacy score descriptive statistics (numeric details corresponding to figure3)

Table S12 .
Pearson's correlations of baseline data with follow-ups for variance inspection for ASCOT score and Efficacy score